Healthcare Provider Details

I. General information

NPI: 1770908105
Provider Name (Legal Business Name): ALDEN ROQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NW 41ST ST
DORAL FL
33166-6202
US

IV. Provider business mailing address

5702 SW 165TH CT
MIAMI FL
33193-4487
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-5366
  • Fax:
Mailing address:
  • Phone: 786-897-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME125550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: